What is your biggest fear as you age? Is it a medical event that leaves you incapacitated or in pain, or both?
It is becoming increasingly acceptable to openly talk about the fact that many of us do not want medical intervention to keep us alive if that life is going to be miserable, in our view – a life with no quality.
The challenge is that the medical emergency that strikes us down is also likely to prevent us from being able to inform the attending ambulance medics and doctors that maybe we don’t want to be ‘saved’ and we want to be left alone to die. The frustration and angst would almost be unspeakable.
How to communicate your message?
The accepted solution is to always carry a document, signed and witnessed, stating you don’t want to be resuscitated.
Your rescuers however will be too frantically busy to look, read and then consider a document hidden in your pocket or wallet. Outside the hospital environment such a document is next to useless.
There is an alternative solution, one that people of all ages but especially older people, are resorting to. It’s a tattoo, usually on your chest above the heart, and it states boldly ‘Do not resuscitate’ (or ‘DNR’). Sometimes the same people will have tattooed on their back, ‘PTO’ for ‘please turn over’.
A commitment in flesh and blood
You could not be clearer in your request and this is obviously made with considerable forethought – you had the message tattooed on your chest for goodness sake!
But even though your intentions are clear, the medical people are unlikely to follow your instructions. According to a British Medical Journal essay from 2011, medical ethics require the consideration of four areas when looking at resuscitation. They are: medical indications; patient preferences; quality of life; and contextual features.
It looks like this:
- Medical indications is where the doctor looks at the goals of the proposed treatment and the probability of success. Will the resuscitation save your life? Will it restore function? Will it prolong life? If the probability of success is high with each of these then resuscitation will proceed.
- Patient preferences acknowledges the principle of respect for the patient’s autonomy. If you don’t want medical treatment you have the right to refuse it no matter the consequences. However at this point in an emergency they have to judge whether you are mentally capable of making an autonomous decision.
Legal people point out that a tattoo may have been done several years ago when you were in a bout of depression. Or was it done as a joke or a dare? The medical people have no way of knowing and the legal people say the medical people must be convinced ‘beyond reasonable doubt’ that your tattoo is still relevant today. - Quality of life is the consideration of the quality of the physical, mental and social aspects of life the person might expect after a successful resuscitation. This is very subjective so the medical world says: will the patient have a good chance of returning to the quality of life the patient had before they needed resuscitation?
- Contextual factors should also be considered – religion, economics, family, mental health, culture and legal factors. What does the law require in this jurisdiction? What other factors, not covered by the previous three points, might need to be considered in coming to a decision?
Facing up to reality
The reality is that medical rescuers usually do not have time to weigh up these complex considerations before beginning CPR etc. They are likely to aggressively commence with resuscitating you, despite your tattooed instructions.
Nor should they be placed in the God role, making ‘life or death’ decisions. For health professionals, it’s their job to save lives. Members of the public are unwitting good samaritans.
Not perfect but that is how it is under current laws. Of-course it is possible that your rescuer will take in a full message like the one in our photograph with a request that has been witnessed and perhaps pause or work a little slower to help your demise.
Which may be a ghastly error. One report stated the person being resuscitated was incredibly drunk as a result of being at a party which they had really enjoyed; they could have died without resuscitation but with resuscitation they went on to enjoy many more parties.
Go figure.
Having a formal Advanced Care Plan, and a legally binding document (Advance Care Directive), shared with a number of family members and key health and legal professionals, is increasingly popular these days.
Find out more from Advance Care Planning Australia.
